Tag Archives: center for medicare and medicaid services

ICD-10 Implementation is not just Doom and Gloom

Doomsday predictions certainly abound – Heaven’s Gate, Y2K, the Mayan apocalypse – and they all came and went with a fizzle. ICD-10 has its own group of “end of the healthcare world as we know it” zealots who predict catastrophe … Read Full Post

Tagged basics of icd-10 coding, center for medicare and medicaid services, coding and billing, coversion to ICD-10, documentation, documentation guidelines, home health agencies, icd-10 assessment process, icd-10 conversion, icd-10 implementation, physician offices, poor documentation, practice management, practicing icd-10, transition to ICD-10 |

Temporary Delay in Implementing Ordering and Referring Denial Edits

Due to technical issues, the implementation of the Phase 2 ordering and referring denial edits is being delayed. These edits would have checked claims for an approved or validly opted-out physician or non-physician. If either of these were missing or … Read Full Post

Tagged center for medicare and medicaid services, delay in ordering and referring edits, home health billing, Imark consulting, phase 2 ordering and referring denail edits, tips on home health billing |

CMS is holding some provider payments

The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release. For claims with dates of service or “through dates” on or after April 1, 2013, the issues affect … Read Full Post

Tagged ambulatory surgical center claims, center for medicare and medicaid services, home health billing, home health claims, homecare billing, Imark consulting, indirect medical education, inpatient prospective payment system, medicare advantage, medicare advantage inpatient prospective payment system, outpatient critical access hospital, rural health clinic |

Tips on Ordering and/or Referring Providers

UPDATE ON 4/25/13: CMS announced the delay of PECOS edits that would result in denial of home health claims & Medicare part B claims when the ordering/referring physician is not enrolled in PECOS. CMS will advise the new implementation date … Read Full Post

Tagged center for medicare and medicaid services, dme, durable medical equipment, hha services, home health agencies, medicare part b, opt-out affidavit, ordering and referring denial edits, part b, pecos |

What We’re Reading – GAO recommends ending CMS bonus payment demonstration

From the GAO.gov website and different healthcare news websites. The Government Accountability Office (GAO), a nonpartisan investigative arm of Congress, recommends that CMS should discontinue its quality bonus program demonstration. The reasons are the budgetary impact, lack of data to … Read Full Post

Tagged center for medicare and medicaid services, cms, government accountability office, hedis program, medicaid cahps, medicare advantage bonus payment system, medicare advantage plans, mra, risk adjustment, the patient protection and affordable care act |

What We’re Reading – CMS Creates New Tip Sheet to Help Specialists Meet Meaningful Use

Navigating through all the information and requirements to meet meaningful use, and to successfully complete the necessary attestation, can be confusing and – at times – complicated for many providers. This tip sheet gives a full introduction of the EHR … Read Full Post

Tagged attestation for meaningful use, center for medicare and medicaid services, ehr incentive program, meaningful use, meaningful use measures, medicaid, medicare |

What We’re Reading – CMS overpaid Medicare Advantage (MA) by as much as $5.1 billion, according to the Government Accountability Office (GAO)

A report issued by GAO the week of March 7, indicates that CMS overpaid the MA program run by private companies by between $3.2 and $5.1 billion for the years 2010-2012. The overpayments were the results of CMS inadequately adjusting … Read Full Post

Tagged america's health insurance plans, center for medicare and medicaid services, cms, diagnostic coding, fee-for-service, gao, government accountability office, medicare advantage plans, overpayments, risk scores |

Home Health Claim Rejections Can Be Easy to Fix

Home health agencies are seeing more claims returned due to code ‘N5052: Beneficiary Identification incorrect.’ This means that the beneficiary’s name and/or other personal data in the CWF transaction did not match the data stored on the beneficiary’s master record … Read Full Post

Tagged center for medicare and medicaid services, home health care billing, home health claim rejections, Imark consulting, n5052: beneficiary idenitification incorrect |

Medicare ACOs: Risk Adjusted Reimbursement’s Mathematical Impossibility (Part 5)

So far in this five-part series on Medicare ACOs, we’ve explored the basics of the concept, the patients’ participation, the fundamentals of reimbursement as well as the provider’s role and incentives. Recall that we explained in an earlier section that … Read Full Post

Tagged aco physicians, center for medicare and medicaid services, managed care plans, medicare acos, medicare advantage plans, medicare fee-for-service, risk adjusted reimbursement |

Medicare ACOs: Healthcare providers and the ACO (Part 4)

The ACO contemplates a paradigm where the entire continuum of care (from physicians to hospitals to rehab centers and everything in between) is coordinated on the beneficiary’s behalf to deliver quality and cost-effective care. In the fourth installment of our … Read Full Post

Tagged center for medicare and medicaid services, fee-for-service methodology, healthcare providers and the aco, medicare acos, medicare beneficiaries and the aco, primary care physicians, quality and cost-effective care, reimbursement |